Shorter treatment for tuberculosis improves success rate

29 October 2014

Ten years of collaboration between the Damien Foundation Belgium
and the Institute of Tropical Medicine in Antwerp (ITM) has produced
a new treatment that could revolutionise global tuberculosis
control.

Currently, the most dangerous threat to global tuberculosis
control is the increasing epidemic of multidrug-resistant
tuberculosis (MDR-TB). Treatment of this serious condition is
difficult due to the treatment length and the toxicity of
second-line drugs. During the past decade, ITM has researched a
shorter, less-toxic treatment regimen, with the support of the
Damien Foundation. The treatment will potentially revolutionize the
global management of this condition.

Patients in The Damien Foundation's Bangladesh
clinic

In what has become known as the Bangladesh regimen, ITM’s Armand
Van Deun and colleagues developed a treatment that takes only 9
months. This regimen replaces the currently recommended treatment of
18 to 24 months. In 2010, the researchers reported that this
treatment increased the success rate from 65% to 88% for MDR-TB
patients in Bangladesh. The treatment is based on a combination of
existing drugs.

The researchers confirm the results in this month’s
International Journal of Tuberculosis and Lung Disease. The
figures regarding over 500 patients have only marginally
deteriorated with respect to their 2010 study on 200 patients. The
researchers report a favourable outcome in roughly 85% of cases, in
spite of increasing levels of serious second-line drug resistance. A
smaller study in Niger confirmed the outstanding results of the
shorter treatment.

In all the studies with the Bangladesh regimen, patients were
provided both the treatment and intensive socioeconomic support by
the Damien Foundation to enhance adherence to treatment.

“The Bangladesh regimen shows that multi-resistant tuberculosis
can now be cured, especially when good socio-economic support is
given to patients. We can avoid resistance if we optimally combine
available medicines and if these principles are respected in TB
control programmes worldwide. It also means that new drugs that are
in the pipeline can have a longer life span,” said Prof. Dr Bouke de
Jong, Head of the Mycobacteriology unit at ITM.

The lifesaving regimen is currently being tested in the STREAM
study, a formal clinical trial in South Africa, Ethiopia and
Vietnam, including countries with higher rates of HIV co-infection
compared to Bangladesh.

About the collaboration

The collaboration between the Damien Foundation, which celebrates
its 50th anniversary this year, and ITM has resulted in several
important breakthroughs. These include global guidelines for
tuberculosis smear microscopy and the fact that high quality
standards for smear microscopy in laboratories can now be assured
throughout the developing world.

The two organisations play an important role in global efforts to
control TB under the coordination by the WHO. The Damien Foundation
and ITM join hands against tuberculosis in Bangladesh, Burundi, the
Democratic Republic of the Congo, Niger, Nigeria and Rwanda.

Worldwide, 9 million people develop tuberculosis annually and 2
million do not survive the infection caused by the mycobacterium M.
tuberculosis. Sixty percent of all new TB cases occur in Asia, while
Africa has the highest rates of new TB patients per inhabitant.